NPI | 1194823336 |
---|---|
Former Name | PAMELA ELAINE CARLSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1805-739) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12195T) |
152W00000X Optometrist (Licence: NM 551) | |
152W00000X Optometrist (Licence: AZ 1592) | |
152W00000X Optometrist (Licence: TX 6697T) | |
Enumeration Date | 2006-09-20 |
Last Update Date | 2023-07-26 |